Provider Demographics
NPI:1316663024
Name:WAKJERA, HAILU T (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:HAILU
Middle Name:T
Last Name:WAKJERA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 TANWORTH DR
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3663
Mailing Address - Country:US
Mailing Address - Phone:571-340-7071
Mailing Address - Fax:
Practice Address - Street 1:1511 EMANCIPATION HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4631
Practice Address - Country:US
Practice Address - Phone:540-899-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist